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Slipped Disk: Conservative Treatment

When people talk about back pain, they usually think of a slipped disc, a painful protrusion and rupture of one of the discs between the spinal bones called vertebrae, leaking jelly-like material which places pressure on adjacent nerves. Other common names for a slipped disk include a herniated disk or spinal disk herniation.

What Is a Spinal Disc?

Spinal discs can be described as shock-absorbing pads between the vertebrae in the spine. There are six discs in the neck (the cervical spine), twelve discs in the middle and upper back (the thoracic spine) and five discs in the lower back (the lumbar spine). Discs are oval-shaped and they are made of cartilage. The middle part of the disc contains a jelly-like substance called the nucleus pulposus. The outer parts of the disc are called the annulus fibrosus and are made up of tough rings of fibrocartilage. The top and bottom of the disc is made of a firm cartilaginous endplate. These endplates are firmly attached to the adjacent vertebrae above and below. Therefore, discs cannot actually slip.

When intact, the rings of the annulus hold the nucleus in the middle of the disc. With repeated injuries, however, the outer annular fibers can tear, allowing the jelly-like material to seep through cracks and squeeze and pinch nerves in the affected area. When the nucleus pushes against the outer wall of the annulus, the result is known as a disc bulge. If it breaks through the outer wall and moves outside the disc, it is called a protrusion or herniation. Therefore, a slipped disk is often referred to as spinal disk herniation.

Causes of Spinal Disc Injuries

Although there are numerous causes of spinal disc injuries, the pain and inflammation associated with them occur as the end-result of many minor injuries suffered over an extended period of time. Prolonged sitting with poor support, repeated improper bending and lifting or trauma from sports accidents can all damage intervertebral discs. Excess weight and sedentary lifestyle are among the major risk factors for developing a herniated disk.

Diagnosing Spinal Disc Injuries

The most common symptoms of spinal disk injury are tingling and numbness of the involved area and pain. If the injury is in the neck, the patient may experience symptoms down the arm to the hand and fingers. If it is in the lower back, symptoms can go down the buttocks and leg to the foot and toes. Examination typically involves testing of sensation, reflexes and strength of the arms and legs. Diagnostic imaging tests, especially magnetic resonance imaging (MRI) or myelogram, are valuable tools for arriving at an accurate diagnosis.

But, not all spinal disc changes are relevant to the patient’s symptoms. Just because there are findings on an MRI it does not automatically mean those changes as the cause of problems. In addition, there is very often overlapping joint and muscle involvement, which can also contribute to radiating leg or arm symptoms. Several studies using MRI and CAT-scans have shown that disc changes ranging from degeneration to large herniations occur in over 30% of people who have never had low back or leg complaints. However, when the disc and/or nerves are severely pinched and inflamed this often causes symptoms.

Treatment of Spinal Disc Injuries

Many people believe that surgery is the only treatment for spinal disc injuries, but the fact is that not too many disk injuries actually require surgery. The great majority of intervertebral disc injuries will resolve or at least improve with conservative treatment. This means conservative chiropractic care which includes ice to reduce pain and inflammation, flexion distraction to restore mobility and reduce inflammation, spinal adjustments to restore joint mobility, reduce inflammation and decrease muscle spasm, electrical therapy to decrease pain, advice on posture and movement to prevent aggravation of the injury, exercise instruction to improve flexibility and strength and acupuncture that may also help to reduce pain and inflammation of the pinched nerve. In rare instances when patients experience progressive weakness or loss of bladder or bowel control, neurosurgical referral will be necessary.

Although intervertebral disc injuries are a very common cause of lower back and leg pain in adults over 40, they often resolve without the need for surgery with conservative treatment, along with activity modification and specific exercise.

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